|Year : 2017 | Volume
| Issue : 4 | Page : 210-214
Tobacco use behavior among construction site workers of Delhi, India
Mamta Parashar1, Shridhar Dwivedi2, Mitasha Singh3, Bilkish Patavegar1, Milan Bhardwaj4
1 Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
2 Department of Medicine and Preventive Cardiology, National Heart Institute, New Delhi, India
3 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
4 Department of Cardiology, Max Smart Hospital, New Delhi, India
|Date of Web Publication||12-Dec-2017|
Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana
Source of Support: None, Conflict of Interest: None
BACKGROUND: Despite various initiatives, menace of tobacco problem still remains a cause of concern globally. Job of construction site workers is primarily monotonous which predisposes to tobacco habit.
OBJECTIVE: Assessing behavior regarding tobacco consumption among construction site workers of Delhi.
METHODOLOGY: A cross-sectional study was carried out among all construction site workers of Hamdard Institute of Medical Sciences and Research and associated HAH centenary hospital, New Delhi. Study included 172 workers for a period of 6 months.
RESULTS: Majority (91%) were tobacco users, and out of these, 49% were using smokeless tobacco, 29% were consuming bidi/cigarette, and 22% were consuming both. Tobacco as cause of cancer was named by 55.8%, while other diseases named were cough (39.5%), tuberculosis (17.4%), and other diseases (25.6%). Warning labels lead to the thought of quitting tobacco in 62.8%. Most common place (97.4%) for tobacco consumption was workplace.
CONCLUSION: Hence the views of workers are of great importance before implementing any anti-tobacco measures at workplace.
Keywords: Behavior, construction site worker, tobacco use
|How to cite this article:|
Parashar M, Dwivedi S, Singh M, Patavegar B, Bhardwaj M. Tobacco use behavior among construction site workers of Delhi, India. Int J Health Allied Sci 2017;6:210-4
|How to cite this URL:|
Parashar M, Dwivedi S, Singh M, Patavegar B, Bhardwaj M. Tobacco use behavior among construction site workers of Delhi, India. Int J Health Allied Sci [serial online] 2017 [cited 2018 Jan 23];6:210-4. Available from: http://www.ijhas.in/text.asp?2017/6/4/210/220526
| Introduction|| |
Tobacco is a risk factor for six of the eight leading causes of death. It is estimated that 80% of these premature deaths will occur among people living in low- and middle-income countries. Although initiatives for all forms of tobacco cessation have increased with time, the menace of tobacco problem still remains a cause of concern globally. According to World Health Organization (WHO), awareness of the harmful effects of tobacco is very low in South East Asia due to which many people use it in various forms for various purposes. If the current trends continue, by the year 2030, tobacco use is likely to kill more than eight million people worldwide each year.
India accounts for approximately a sixth of the world's tobacco-related deaths. As per the WHO Global Report on “Tobacco Attributable Mortality” 2012, 7% of all deaths (for ages 30 and over) in India are attributable to tobacco. In India, nearly two-thirds of the contribution to the net domestic product is by the unorganized sector. Also known as informal labor which is defined as those not governed either by state regulations or by collective agreements between workers and employers. Notable differences in smoking rates are seen across occupational groups, and significantly, higher tobacco consumption rates have been found among construction site workers. Migration from rural areas necessitates alterations in social status and living conditions that result in behavioral adaptations to urban life.
Understanding the tobacco-use knowledge, attitudes, and behaviors among workers is of significance in the provision of behavioral therapy for smoking cessation.
Thus, their views and attitudes are of great importance to be determined before implementing any anti-tobacco measures. Although there are several studies to investigate the tobacco behaviors among migrants and other population, there is a scarcity of literature focusing individually on the population of construction site in Delhi. The objective of our study was to investigate behavior regarding tobacco consumption among construction site workers of Delhi.
| Methodology|| |
Study Setting: A cross-sectional study was conducted using a predesigned and pretested structured pro forma. The study was conducted among all construction site workers aged 18 years and above in campus of Hamdard Institute of Medical Sciences and Research and associated HAH centenary hospital, New Delhi. This study is part of a project which included 172 workers for a period of 6 months (September 2014 through June 2015). The project recruited the workers, and along with the present interview nicotine dependence, intention to quit and cardiovascular with biochemical assessments were also conducted.
All adult males and females (age above 18 years) in a payroll of construction site and willing to participate were included.
Workers who were unable to respond to the questions (due to hearing problem or any other reason) were excluded.
Necessary permission to conduct the study was obtained from the concerned authority of the construction site. Written informed consent was obtained from the workers after explaining the nature and objectives of the study in their local language. The study was approved by the Institutional Review Board and Institutional Ethical Committee of Jamia Hamdard, New Delhi.
Outcome variables: knowledge, attitude, and practice of workers about smoked tobacco/smokeless tobacco (SLT).
Education, occupation, age, socioeconomic status, and migration.
Method of data collection
Data were collected by face-to-face interview method using predesigned, pretested WHO adopted Questionnaire on tobacco use. First, we contacted contactor at construction units for permission to conduct the survey in their premises. On receipt of this permission, we then contacted recognized group “leaders” who mobilized and encouraged their coworkers to participate in the study. The study purpose was explained to all eligible participants, and informed consent was obtained from all who elected to participate. All surveys were administered by local medical professionals, who were trained in research survey methods. The recruitment and data collection of participants lasted for 3 months. Each week, around 15 workers were worked up by the interviewers and medical professionals. Questionnaires were checked by investigators for completeness. Following completion, all participants were given a token of appreciation (free medicines if required) and counseling in tobacco cessation clinic. They were referred to appropriate department if any health problem was identified.
Operational definition and statistical analysis
Data were stored in Microsoft Excel and subsequently analyzed by using SPSS version 16.0 software package (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Exploration of the data was performed before analysis to determine missing values and the distribution (normality) of the variables. Both descriptive and inferential statistics were applied wherever appropriate. Descriptive statistics was used to describe patients' demographic information, knowledge, attitudes, and tobacco-use behaviors. Knowledge on tobacco use was evaluated using total score for each participant, with one point for each correct answer and zero points for each wrong answer. The possible score in knowledge domain for each individual ranged from zero to five. Student's t-test and ANOVA test were applied to determine demographic differences in knowledge.
| Results|| |
Demographic characteristic and knowledge scores among workers
Of the 250 workers enrolled, 172 (68.8%) male workers agreed to participate in the tobacco-use survey. Mean age of construction site workers was 32.1 (standard deviation, 11.6) years. Among the study participants, less than half (44.2%) were illiterate, and one third (33.7%) completed primary education. Majorities (72.1%) of the study population were laborers and 27.9% were involved in skilled and other types of work. Most of them (94.1%) were migrants from Uttar Pradesh, Bihar, and West Bengal. Majority of the participants were tobacco users (90%), of which 49% were SLT users, 29% smoked bidi/cigarette, and 22% were dual users. [Table 1] shows the proportion of the respondents who answered correctly each item of tobacco-use knowledge. More than half (55.8%) of the population had knowledge about harmful effects of smoking while it was 46.5% for SLT. Only 23.3% were aware that second-hand smoke could also be harmful. Most of workers (90.7%) had received tobacco-related information through media. Tobacco is related to cancer was named by 55.8% while others named tuberculosis (17.4%), cough (39.5%), and other diseases (25.6%). Significant association was found between literacy, occupation, marital status, migrants, and tobacco-related knowledge [Table 2].
|Table 1: Correct knowledge among construction site workers regarding tobacco use|
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|Table 2: The influence of participants' characteristics on tobacco-use knowledge|
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Attitudes regarding tobacco use
Less than half of the participants believed that tobacco use is a fun (47.4%) while others believed that it makes them free from all stresses of life (14.7%) and relieves constipation (8.9%). Around 64% noticed health warnings on tobacco product packages. Among them, warning labels lead to the thought of quitting tobacco in 62.8% users.
Behavior regarding tobacco use
It was found that a higher proportion of the workers started smoking cigarettes at younger age (mean age 9.6 years) when compared with SLT use (mean age 14.4 years). Nearly one-third of smokers smoked more than ten cigarettes/bidis per day. Average frequency of SLT use per day was 4.7. Most of them (80%) spent five hundred rupees on tobacco per month. The most common place (97.4%) for tobacco consumption was workplace. More than half (56.4%) of the tobacco users had some family member who smoked/chewed tobacco, suggesting that the tobacco use is common in families with tobacco habit [Table 3].
| Discussion|| |
The present study investigates the tobacco habit of construction site workers in Delhi. Mean age of workers was 32.1 ± 11.6 years. In another study, mean age of workers was 26.3 ± 8.5 years which is lower than that reported in this study. Nearly half of the tobacco users in our study were aware that tobacco was harmful; however, majority were having little knowledge about the harmful effect of passive smoking. Mishra et al. reported that all tobacco users were aware about its harmful effects and most (97%) of them identified passive smoking as being dangerous for health. In rural Kerala, 96.6% of the individuals knew that tobacco use is harmful for health; however, only 22.5% knew that it causes cardiovascular diseases. Differences in knowledge may be attributed to the different study location, sampling frames, and demographic characteristics of the individuals enrolled. The majority were only aware that tobacco caused cancer and media was the common source of information similar to findings in another studies., Higher education, income, and type of family were associated with higher awareness in the same line with other studies.,, Participants from our study regarded smoking as a fun and this finding was also observed by a study conducted in Malaysia. Study done by Akram et al. in Mangalore among industrial workers found prevalence of tobacco use as 53.7% and prevalence of smoking and tobacco chewing was found to be 11.9% and 41.8%, respectively. The mean age at initiation of cigarette smoking and chewing tobacco was lower in our study than as reported in other studies. The average monthly expenditure on tobacco use in the current study's participants is <500 INR. Employees using smoked form of tobacco spent significantly higher amounts of money as compared to the employees using smokeless forms. In a study from Nepal, the average daily expenditure on tobacco was 20 Nepalese rupees (~0.3 USD). In the present study, most of the worker smoked and chewed tobacco at workplace. Literature suggest,, that rates of tobacco use are especially elevated among workers, particularly those employed at construction site. These workers are employed in settings generally less supportive of nonsmoking. For example, studies from across the world,, reported a lower prevalence of restrictive smoking policies in worksites where they are employed and less assistance in quitting smoking from employer compared with the assistance reported by other workers.
Though the study provides useful information, it may have some limitations. The survey was done on workers from a construction site in Delhi; hence, the results can only be generalized to the sampled population. Our survey was cross sectional, and smoking/chewing status was by self-reporting. Therefore, some participants may have not reported or overreported their smoking/chewing habit. In spite of these limitations, we believe that our findings have not been significantly affected.
| Conclusion and Recommendations|| |
Our findings indicate a need for tobacco control among this subpopulation. Despite good knowledge regarding health hazards, tobacco-use prevalence was very high among construction site workers. Effective behavior change communication package is required to elaborate the scope of warning labels on tobacco packs with focus on other potential hazards of smoking such as heart disease, hypertension, chronic lung disease, and infertility as well rather than just focusing on cancer. Most of workers smoked/chewed tobacco at workplace. Reconsideration of current tobacco-free legislation as it applies to the construction site is also required. Special efforts should be taken to educate workers on the effective strategies in managing stress due to workplace as they thought that tobacco should be used as a coping strategy to face such a stress.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ministry of Health and Family Welfare, Tobacco Control Legislation and National Tobacco Control Programme. Annual Report (2011-2012). MOHFW, Government of India; 2012. p. 162-5.
John RM, Rao RK, Rao MG, Moore J, Deshpande RS, Sengupta J, et al
. The Economics of Tobacco and Tobacco Taxation in India. Paris: International Union Against Tuberculosis and Lung Disease; 2010. p. 1-49.
World Health Organization. Global Status Report on Non-Communicable Diseases 2010. Geneva: World Health Organization; 2011.
Shah C, Sonaliya KN, Mehta HK. A study of socio demographic profile and addiction pattern among construction workers in Ahemdabad city, Gujrat. Indian J Prev Soc Med 2012;43:188-91.
Liu Y, Song H, Wang T, Wang T, Yang H, Gong J, et al.
Determinants of tobacco smoking among rural-to-urban migrant workers: A cross-sectional survey in Shanghai. BMC Public Health 2015;15:131.
Zhu C, Geng Q, Yang H, Chen L, Fu X, Jiang W, et al.
Quality of life in china rural-to-urban female migrant factory workers: A before-and-after study. Health Qual Life Outcomes 2013;11:123.
Aslesh OP, Paul S, Paul L, Jayasree AK. High prevalence of tobacco use and associated oral mucosal lesion among interstate male migrant workers in urban Kerala, India. Iran J Cancer Prev 2015;8:e3876.
Parashar M, Agarwalla R, Mallik P, Dwivedi S, Patvagekar B, Pathak R, et al.
Prevalence and correlates of nicotine dependence among construction site workers: A cross-sectional study in Delhi. Lung India 2016;33:496-501.
] [Full text]
Parashar M, Singh M, Agarwalla R, Panda M, Pathak R. Predictors of intention to quit tobacco among construction site workers in Delhi, India. Indian J Psychiatry 2017;59:208-13.
] [Full text]
Parashar M, Dwivedi S, Agarwalla R, Kishore J, Shaikh Z. Risk factors for cardiovascular diseases among male workers of building construction site in Delhi. J Clin Prev Cardiol 2017;6:99-103. [Full text]
Centre for Disease Control and Prevention. Tobacco Questions for Surveys. A Set of Key Questions from the Global Adult Tobacco Survey. (GATS). 2nd
ed. Atlanta GA: Centre for Disease Control and Prevention; 2011.
Adsul BB, Laad PS, Howal PV, Chaturvedi RM. Health problems among migrant construction workers: A unique public-private partnership project. Indian J Occup Environ Med 2011;15:29-32.
] [Full text]
Mishra GA, Shastri SS, Uplap PA, Majmudar PV, Rane PS, Gupta SD, et al.
Establishing a model workplace tobacco cessation program in India. Indian J Occup Environ Med 2009;13:97-103.
] [Full text]
Tiwari R, Deb P, Debbarma A, Chaudhuri R, Chakraborty A, Lepcha M, et al.
Tobacco use and cardiovascular disease: A knowledge, attitude and practice study in rural Kerala. Indian J Med Sci 2006;60:271-6.
] [Full text]
Siahpush M, McNeill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: Results from the 2002 International Tobacco Control (ITC) four country survey. Tob Control 2006;15 Suppl 3:iii65-70.
Khawaja MR, Mazahir S, Majeed A, Malik F, Merchant KA, Maqsood M, et al.
Chewing of betel, areca and tobacco: Perceptions and knowledge regarding their role in head and neck cancers in an urban squatter settlement in Pakistan. Asian Pac J Cancer Prev 2006;7:95-100.
El Fakir S, Serhier Z, Berraho M, Elrhazi K, Tachfouti N, Slama K, et al.
Knowledge and perceptions of smoking according to income level in Morocco. Am J Health Promot 2011;25:387-91.
Awaisu A, Nik Mohamed MH, Abd Aziz N, Syed Sulaiman SA, Mohamad Noordin N, Muttalif AR, et al.
Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia. Tob Induc Dis 2010;8:3.
Akram S, Gururaj NA, Nirgude AS, Shetty S. A study on tobacco use and nicotine depen-dence among plywood industry workers in Mangalore city. J Evol Med Dent Sci 2015;4:5729-35.
Sreeramareddy CT, Kishore P, Paudel J, Menezes RG. Prevalence and correlates of tobacco use amongst junior collegiates in twin cities of Western Nepal: A cross-sectional, questionnaire-based survey. BMC Public Health 2008;8:97.
Okechukwu C, Bacic J, Cheng KW, Catalano R. Smoking among construction workers: The nonlinear influence of the economy, cigarette prices, and antismoking sentiment. Soc Sci Med 2012;75:1379-86.
Ham DC, Przybeck T, Strickland JR, Luke DA, Bierut LJ, Evanoff BA, et al.
Occupation and workplace policies predict smoking behaviors: Analysis of national data from the current population survey. J Occup Environ Med 2011;53:1337-45.
[Table 1], [Table 2], [Table 3]